Regina Bielawski, MD

Regina Bielawski, MD

Geriatrician

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Patient Forms

Welcome to Baptist AgeWell. To help expedite your first visit, we provide our health forms online so that you can print and complete them at your convenience. If you have any questions, please don’t hesitate to contact our office staff.

Baptist AgeWell Forms

  • Advance Directives Information

    Baptist Health encourages all patients to discuss future healthcare decisions with family and health care providers. That's why we offer advance care planning resources and tools, actionable next steps and forms to help you plan your care if ever faced with a serious or life-limiting illness.

  • Authorization for Use of Voicemail

    Authorizes Baptist Health to leave appointment, referral and test results information on your voicemail.

  • Authorization for Use of Voicemail

    Authorizes Baptist Health to leave appointment, referral and test results information on your voicemail.

  • BPC Patient Registration and Authorization

    Captures patient demographic information, insurance information and authorizes Baptist Primary Care to prepare and submit your medical bill directly to your insurance company.

  • Medical Records Release

    Request to have your medical records sent to another medical provider.